[Small-area and socially differentiated analyses of the utilization of screening examinations in the city of Hamburg: a secondary data analysis]

Introduction: Social reporting in Hamburg identifies existing inequalities at the urban area level. These social-contextual variations may potentially influence preventive health behaviors. The aim of this article is to examine correlations between the degree of social regional disadvantage of Hamburg's population and the utilization of regular screening examinations for children, adolescents, and adults through small-area analysis.

Methods: The analyses are based on claims data from 2017 of insured individuals living in Hamburg from three cooperating statutory health insurance funds. A socially contextual indicator (1 = "very low" to 7 = "high") was assigned to the data at urban area level. Based on this, binary correlations between the social indicator and calculated utilization rates (stratified by gender and age) of early detection examinations were examined using Kendall's tau correlation analysis.

Results: The study population included N = 433,053 individuals (53.7 % female) from the city of Hamburg. Strong positive associations were found between utilization rates and social contextual index classes for U7 to U9 examinations (r > 0.7; p-values < 0.05) as well as cervical cancer screening (r > 0.9; p-values = 0.002), indicating that utilization increases with the rising social status of the urban area level. Additionally, strong positive correlations can be observed in some subgroups for prostate cancer screening (> 59 years: r = 0.905, p-value = 0.004) and colorectal cancer screening (women aged 50-60 years: r = 0.905, p-value = 0.004). No significant correlations were found for other subgroups, as well as for skin cancer screening, breast cancer screening and the J1 examination (p-value > 0.05). Strong negative associations have only been detected for the general health check-up for individuals aged 35 to 59 (women: r = -0.810, p-value = 0.011; men: r = -0.714, p-value = 0.024).

Discussion and conclusion: The results indicate inequalities in the use of early detection examinations provided by statutory health insurers for children and adults to the disadvantage of urban areas ranking lower in social status. This socially selective utilization may lead to an accumulation of health problems in urban areas that are already disadvantaged socially, which would result in an exacerbation of existing social and health inequalities. Small-scale and socially differentiated analyses of healthcare provision should be seen as a regular component of regional healthcare provision. They provide starting points for a more needs-oriented further development of the healthcare system and secondary prevention services.